There will be some form of mental health reform bill passed. Politically the Congress has been shamed for not doing anything and they will do this to demonstrate that they are actually working. The new bill will be watered down, it is only a concession, after all. I am in favor of the original Murphy Bill; a bit concerned about how it will be implemented and enforced because much legislation is not enforced once it has been passed; such as the restraining of pregnant women in prison. It is still going on as is probably sterilization as part of plea bargaining

We have very different perspectives, opinions and life experiences. I am the social worker who was faced with putting a woman on a hold or letting the police officers take her to jail and I wrote a blog about it with dire results. Having worked in the jail, of course, I had a different view of the abuse she would suffer there. Anyway I always seek out your posts because they are so darned informative, beautifully phrased, interesting and often funny. Just to let you know this and you are my one link with MIA One day we will embrace each others differences and find our similarities and move forward

Again, what SHE does to others is less of a concern then my comment to your post. Let’s not compare and say “She did it to this person, or that person” We all have to try to be empathetic, if someone is having a hard time putting themselves in other’s shoes we await this capacity to unfold and model empathy in our own behavior.

In this and other comments it appears as though you are interrogating this person. She has not committed a crime by coming to this site and others need to respect her privacy and just listen with empathy. The authors first step may be to voice her views. Let her maintain some dignity and listen with compassion and the “open arms” and “safe place” that this site advocates for

Why do you keep coming back to this site? When you previously were here, Leah Harris tried to have a civil dialogue with you to no avail and stopped engaging with you People responding to your posts might want to check the archives of these exchanges.
It seems that when someone has a different point of view, that it is not respected. People come to the site for information, inspiration and open minded discussions. Questioning someone about why they come to the site is not empathitc at all. The person has a “need” and you need to respect that even if you don’t understand it

OK I get it the issue is having been on or being on meds is the criteria for disability. I thought that the Soc Sec Disability folks needed a diagnosis with a doctor’s note or documentation. Now I know better, thanks

When I worked on an unit. The docs really liked me and said I had great ego strengths! Luckily this was back in the day when the care was at least adequate. I was well liked by staff and the patients though I didn’t know what I was doing many times and I regret my ignorance greatly now. What happened to those days? I was pretty uninformed in those days also but our empathy was there and it was appreciated more than any “expertise” so don’t regret anything!

Michael
True and applicable. For me, I was shocked when I had my 4 month experience at age 21 but having grown up with my little neighbor who was hearing voices from age 4 (he was my best friend) I had a feeling that it could happen to anyone. At 21, though, I felt that the chances were pretty much near zero that I would have the same experiences. Had I not gone through it with him and myself, I fear that I would have fallen into the same denial/fear based mode of being impervious and kind of “protected” by my really good parents, my “ego strength” my ability to handle a lot of pressure. This attitude is, of course, discriminatory as most fear-based attitudes are but is something all professionals ( and others) need to be very aware of and question within themselves. The other factor is that the more you experience other people’s experiences and see them live through it and gain insight, the less fear there is and, of course, empathy grows. I think all who are going into the field must be with people who are living with and through these states although nothing compares with going through it yourself. Many of my colleagues don’t really get it and do have some empathy but that is not the same and it is not the kind of “understanding” that leads to complete and deep empathy

Stephen
Amazing that you can work there ! Fortunately I have had 20 years experience with psych nurses and I can say that they were the ones who took patients into their private offices, gave them food and clothes, let them use the phone, let them vent and this was totally against county rules in the hospital. Must have been very different in years gone by. I miss those times.

Exactly! It is cheaper to use meds than to train or hire staff to provide a safe place and time to talk to patients. This was not always the case, as I can attest to, and when this shift took hold I had transferred to the jail. I believe what you say…its going to be hard to reverse this because it is so financially lucrative for hospitals and for the pharma companies. I still know therapists and many psych nurses who spend time with people but the economic and political backlash is pretty fierce.

There are many therapists like myself who are educated and trained outside of the “diagnostic model” Our mission is to “begin where the individual is” the person’s feelings, interpretations, dreams and wishes are always our starting and end point. Of course I was educated long before the Prozac era and before medications became a first line treatment. I know many therapists who follow this golden rule. We are older and wiser?

As long as you continue to lump all social workers together and consider that in all settings we have “authority” (I was very low on the scale and psychiatric nurses earned 10,000 more than I and had more authority) then there is no discussion. My friends (psych RN’s) are wondering just how many settings you worked in and how your conclusions can be drawn from a small sample including individuals who share your opinion. You are not correct in your conclusions and the generalizations along with the “authority” issue is a barrier in this dialogue. I will say this even though you will probably take offence; you sound very dogmatic and authoritarian on the subjects that you discuss; there is no compromise, no looking at things from a different perspective. It’s almost like those individuals who have freed themselves from cult-like experiences but have taken on the authoritarian tone now that they are liberated, without being aware of it.

Again the “power” and “authority” issue. You seem to perseverate on the illusion that therapists have those characteristics. There is no point discussing this again because this perception reduces you to a powerless individual and thus we are not on the same playing field. Also turning the issue around so that the other person is “defensive” instead of looking at the problem of equating therapy with prostitution is a sticking point. The issue was the black or white view of therapists; all bad or all good that was the point of my statement. There are good and bad therapists, good and bad nurses, good and bad people, good and bad doctors……..

B you said in a former comment, to “There’s no place like Home” that you almost killed yourself because of someone like me (I am a social worker) You have a grudge here and need to control your hostility towards all therapists; your message is lost in your harmful and angry words.

You are amazing we need to teach people how to demand therapy in a system that targets medication as cost efficient, time efficient and then has to deal with the expensive post medication effects.
Lucky or brilliant that you found a good therapist….can you share what insurance plan? or is it private pay?

“got the idea of creating a “hospital at home” from Jessica Arenella, President of ISPS-US. When our patients are in an extreme state, we make sure they’re safe at home, see or call them once or several times a day, help them and their families understand what’s happening, and offer meds and/or healing techniques of various kinds. It works very well, especially for people who have had mixed or bad experiences with hospitals in the past.”

There are many people in extreme states without homes. Families will tell you as they have told me many times that their loved ones in extreme states threaten them, isolate in their rooms and refuse to communicate and the family is traumatized and helpless.

Victimized? not at all. I can see that I am reading comments from people who have no lived experience with certain topics and repeat the same old mantra about medications, side effects etc. and who cannot imagine the responsibility of people who live with youngsters who are severely damaged. Just comment on what you know from your own experience and appreciate the work and opinions of individuals who have quite different experiences.

How do you compare a “bright” child in a boring classroom to a child with extreme damage both emotionally and physically (brain damage from abuse)? You have talked to dozens of children…have you lived with them?

I agree. You are going to get a great deal of angry responses for supporting a medication approach to individuals who are beyond repair via normal nurturing. Stay on track here..my lived experience with young and adolescent individuals who are extremely biologically damaged by trauma and other factors informs me that there are times when the adverse effects of medication pale in comparison to their benefits even though these “benefits” may have effects of their own. You and only you know what these children are like on a 24/7 basis. Others are speaking from limited or no experience at all. Stay strong

Agreed. I think that guns are a more “exciting” media popular and politically useful issue for most people. A gun represents so many of America’s skewed values; male-dominance, power and control, even sexual prowess. Emotional distress for most people is a frightening and confusing issue and they like to steer clear of focusing on it.

Agreed. I would like to know about the 6 week trial of a drug and the FDA approval. We also need to have real scientific evidence of long term use of the drugs and exactly what they do to the brain. This whole domain is so politicized and pharma-controlled that it definitely is a crap shoot to use drugs even for a very very short time and I fully understand that. I don’t think we need to “attack” meds, we need to avoid any kind of usage unless there is absolutely no alternative and the options are reduced (as they are in the ER) to restraints or jail.

Sorry you are experiencing the pain. I’ve been the recipient of the same thing. Take time and think through how you want to handle it as I know how it feels and I took some time to consider what to do.

I would only support medication use in an emergency situation and then a period of time to allow the person to recover their ability to think, talk and self-direct. I’ve seen this protocol in the ER (Oliveview UCLA) and then in the in-patient unit where the person went for a few days and ate, slept and talked….was able to think about a shelter-resource program and was released. Of course this was fairly recent, and the resident psychiatrists were better informed about meds. In my case, many decades ago, there were 2 choices in “extreme” psychosis; either the deadly older meds or being locked in your room at home. That was the choice my family had; they just left me alone because they could not communicate with me (I was too paranoid to know who they were). I did slowly recover but it was hell and if it happens again, I hope that someone will relieve me of those symptoms as fast as possible; I don’t care if I sleep for 2 days its better than the agony of paranoia, terror, utter confusion.

I agree with all above. when I wrote my article ( and when I experienced my extreme state at 21) I was describing the state which you call nuclear; there is no chance of getting one’s thoughts together, there is extreme terror, no sleep, agitation, inability to communicate anything) and I was telling the story of one of my people in the ER, in that state, and the time I spent trying to connect, to hold, to reassure, to feed, to enable him to feel in control of the situation so that he could help me find a place, a person, something so that I could provide some safety for him or the police were going to pick him up again, get angry, tase him etc. My point was that it was terribly difficult to, after hours of work, put him on a hold. When the article was posted I got hateful comments, was compared to a Nazi (some of my family died in the concentration camps) and was told that I was controlling, authoritarian and had sentenced him to death. I always check back and he spent 3 days in the hospital, had one initial dose of meds, ate, slept and was able to accept going to a shelter program with case managers on site. I don’t agree with meds unless a person is in a terribly extreme state and then the person needs time to talk, recover their ability to think, talk and direct their own pathways. Recently Dr. Hoffman who comments here and who said that he would never write a hold, messaged me on facebook and said that he could see the need for holds in such cases. So I don’t know if my initial post was miss interpreted? I am not pro-meds or pro-holds or pro-coercion in any form. Anyway, I still feel sad and abused from the comments that I did receive and I want to clarify my position here.

There is a correlation between psych drugs and the worsening or onset of aggressive/hostile/sometimes violent behavior against self or others. The problem is terribly complex; The recent shooting, for example, the mother is quoted as saying that Mercer’s problems were when he was off of his medication;“She said that ‘my son is a real big problem of mine,’ ” Ms. Jefferson said in a telephone interview. “She said: ‘He has some psychological problems. Sometimes he takes his medication, sometimes he doesn’t. And that’s where the big problem is, when he doesn’t take his medication.’ ” However, how reliable is she as a reporter? How long does this medication remain in the system,? when did he start the meds? was he in a rage and vengeful before any meds were started? It will take decades to unravel the story and for each person it may be different, plus these shooters (most of them) are dead and cannot fill in the missing pieces. It would be useless to tell everyone to taper off of their meds; it wouldn’t happen and some would certainly do it wrong. People on any meds need to be monitored or they shouldn’t be given meds in the first place since these substances do change the brain. Will careful responsible monitoring take place? I doubt that. So we are left in limbo here and I still think that we need to focus upon our youngsters and identify those who are becoming victimized, angry, bullied, shamed, isolated, and doing poorly in school. Intervene early; the problem here is that funding for school counselors has been drastically cut; yet another barrier and screening instruments are problematic. The issue falls on the shoulders of families at this point; and that brings up the need for education and the problem of lack of family support and availability (no father in the home, etc). Where do we go from here?

I agree and a few points; The data on correlation/causation of violent behavior by psych drugs can be used by pro or anti drug groups to support their agenda. If the individual was off the drugs they can say that the drugs could have prevented the violence if he or she were taking them, for example. I think that what you pointed to and what we are missing is the early development due to trauma, deprivation, rejection and shaming of the person who became violent. Early history is demonstrated in school performance, instances of bullying, violence towards pets and siblings etc. This cannot be distorted, refuted or politicized. The meds issue, while very valid is so political and the data (statistics) are going to be manipulated by both sides. Self report on the effects of meds is vital but is being discounted now by researchers. I can vouch for the effects of Prozac, for instance, I had to taper off since it de-sensitized me to any kind of human suffering and as a social worker that didn’t work at all for me. So let’s stick to the history and development of extreme rage, loss of empathy, deprivation and especially the traumatic effects of isolation, rejection, shaming and abuse.

The problem here is that Black Americans who experience emotional problems turn to their spiritual, family and community support systems. The MIA format and the way in which issues are explored are not the way that they say they perceive the whole domain of emotional pain, it’s causes and how to manage it. There are websites that I have researched that are written by Black Americans that fully describe their perceptions, their mistrust of the “White” mental health system and its advocates and their avoidance of sites like MIA is made crystal clear in their own voices. Try to do the research and you will see what I mean.

Your comment is valid; screening is risky given all of the points made. It takes the place of people who are close to the individual taking the time to talk to them and find resources but people like to pass on responsibilities and to take the wait and see what happens attitude. And of course if the person screens “positive” that adds to the stigma and shifts them into a diagnosis. I firmly believe that family and friends can do the observing, identifying and guiding but then again many people with severe emotional distress have lost their support systems or their support systems are woefully dysfunctional also. Screening is a diversion and delay tactic at least at this point in time; it will look politically grand and pay salaries for computer geeks to format the docs and then others to do the screening. I bet this idea will take hold, it is politically and economically a boon for many

I think that one of the issues here is that we are talking about very different levels of extreme states. I am focused on the individual who is not able to function due to the experiences of negative command hallucinations, delusions that put them into high risk situations, agitation and fear to the extent of not being able to communicate. Do you agree that there are various intensities of extreme states? I have had my own experience (in college) and was non-functional for several months, kept in my room at home, had to drop out of school. It gradually resolved on its own and at that time my parents did not want me to take the meds because they were the primitive Thorazine and Stelazine. So I would never want to undergo that again and would take some meds temporarily, but my point is that my state was really close to being totally disabled and I think that the next rung in the ladder would have been close to what I see in the ER. this is not what other writers are describing as far as I can see. Do you agree that we are talking about different intensities of experience and that some of these states can be experienced while being a functional, working, family-involved person and the more extreme state is one that no one would willingly undergo because it is too disabling?

Alice, your approach is balanced, reasonable and clearly you connect emotionally with your patients and their families. Many people think in black or white categories and their anger towards the prevailing systems of mental health preclude real dialogue or action. The predominant feelings of rage and the focus upon harm and stigma are paralyzing in terms of progress. We need to use all of our strategies in order to help people who have serious symptoms continue to work, be with their families, sleep and function. I think that the philosophy of encouraging oneself or another person to indulge in “extreme states”, or transforming experiences for any length of time is, quite frankly, a possible pathway to loss of friends, loss of family, job etc.. What happens to one’s family (children) if one is going through the “extreme state” without emergency medication or treatment? Who cares for the family? I find little mention of this and it is of concern to me.

There is a wonderful multi-faceted approach that is actually in use and successful. It is by Dr. Stephen Seager who is a psychiatrist at Napa State Hospital and he uses many approaches with great success. He will also be producing a film with families and others who benefit from his work. He is an advocate for reform of the mental health system inside and out.

Dear Corinna
I follow your journey and I believe that you are taking responsibility for your own ups and downs with recovery in a unique way. So many people blame others and become enraged to the point that they lose sight of what the goal is; to find ways to live a gratifying life and share these strategies and insights with others. Again, you are amazing in the way that you put resources together, either reach out or do it on your own and always take responsibility for the outcome. Much praise from me and continue to inform us.

A few things and then I have to do more research on a respite that opened recently (saw it on Facebook) to find out where they obtained their funding so that I can pursue that in my area. As I noted in prior articles I always follow up on people; Mary went to Olive View UCLA where they set a broken finger and she met with an advocate prior to her probable cause hearing. she was not deemed “holdable” was not put on a 14 day hold, she was not given meds because they were concerned about her weight loss and dehydration. She was discharged with a list of shelters. In this hospital system (where I worked for more than 17 years) they do avoid medication keeping people as in-patients partly due to the fact that this is an LA County facility with no private funding and the staff are residents from UCLA. OK, now on to my mission that is to get respite-peer programs in this area; here is the info on the new voluntary short term 16 bed respite that just opened in another area of California. If anyone can help sort out how they obtained funding while I email some of the individuals on the site, I would be grateful.
Jay Mahler
NOVEMBER 1, 2012
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Peers Envisioning and Engaging in Recovery Services (PEERS) is a non-profit organization.
333 Hegenberger Road, Oakland, CA 94621
(510) 832 7337 | Contact Us
So thank goodness there was this funding cut, because then I got into a group with other people who had mental health issues, and I had a very good psychologist named Dr. Moore. It was Dr. Moore that encouraged me to go major in psychology so studying other approaches, going back to school was very important, getting a job.
My mother had passed away, but a good friend of hers worked for Kelly Girls. So I actually got, she got me a job through Kelly Girls working at a drug store, and that was very significant to my recovery.
So there were a number of things over a several-year period, including going to church. It was very important for me to go to church and kind of get in touch with my spiritual side that was totally denied and devaluated by the public mental health system.
Today, across the country, started by the National Alliance for the Mentally Ill, Prayer Days, National Day of Prayer Days are happening for those of us with serious mental health issues. And we know that 80 percent of those with serious mental health issues are unemployed.
So today, I hope we’ll pray that people get jobs. We know that people with mental health issues are dying 25 years earlier than the general public. They die at 52 instead of 77. We recently lost DeWitt, Darnell, Michael Bell. We pray that we live longer, that we get the physical health needs that we need. When I first got involved with the consumer/survivor movement it was very much anti-public mental health system.
Most consumer/survivors would have nothing to do with the public mental health system. So I was the person who was willing to develop relationships with providers that shared our approach and to try and work with the system to listen to us and to do things that would support us.
To me, most importantly the consumer movement is a civil rights movement. It really started by many of us who have been mistreated and poorly treated in state hospitals and hospitals, and came together to try and call attention to what was wrong with the system and for us to support each other and validate what we had been through.
Currently I work for Alameda County Behavioral Health Care Services as the Consumer Relations Manager. We’re responsible to make sure that the consumer voice is reflected in the transforming of the public mental health system.
Most consumer/survivors would have nothing to do with the public mental health system. So I was the person who was willing to develop relationships with providers that shared our approach and to try and work with the system to listen to us and to do things that would support us.
To me, most importantly the consumer movement is a civil rights movement. It really started by many of us who have been mistreated and poorly treated in state hospitals and hospitals, and came together to try and call attention to what was wrong with the system and for us to support each other and validate what we had been through.
Currently I work for Alameda County Behavioral Health Care Services as the Consumer Relations Manager. We’re responsible to make sure that the consumer voice is reflected in the transforming of the public mental health system.
Literally what I’m doing now, I’m actually kind of phasing out. I’m going through a process of retiring and figuring out what I am going to do. But you never retire from a cause, so what I’m really hoping to do is to work on spirituality and on this 10×10 Campaign which an effort to try and improve the life expectancy of people with mental health issues.
It is a tragedy that people with serious mental health issues die on an average 25 years earlier than the general public. So people with mental health issues are dying at 52 instead of 77. I think before I had my nervous breakdowns, I didn’t have very much sensitivity to people that were going through difficult times. I think that what I have been through personally has helped me try and be sensitive to other people who are going through difficult times no matter what kind of situation it is. And, also I think that being involved in the consumer/survivor movement has given me a purpose in life. It gives me something meaningful and I feel I’m making a contribution.
Jay Mahler
NOVEMBER 1, 2012
PEERS is a 501(c)(3) nonprofit organization. Contributions are greatly appreciated and are tax deductible.http://www.peersnet.ohttp://www.acgov.org/board/bos_calendar/docum

Please refrain from assuming what happened with Mary is the same as what has happened with you. Please take caution when interpreting what she may consider “worse than death” or what she is thinking and feeling. Please do not base other people’s experiences upon your own. Please move forward and accomplish the goals that are being destroyed by the fear and anger that is obscuring the message.

A couple of questions (you don’t have to answer, of course) what is your own description of your fight or flight response? Did the hospital make you involuntary because you said you were suicidal and homicidal? Do you have any respite services in your area for people in acute emotional states? this is what we so desperately need for people who don’t have family or friends who can compassionately see them through the terrible and frightening episodes.

Yes, the brain as a intricate combination of systems is part of the whole behavioral environment. One cannot explain or understand behavior, thought and feeling by eliminating neurotransmitters from the picture. There is so much yet to be done and until there is a better understanding of this complex picture, consumers and doctors need to be very, very cautious about what they recommend and what they take. Every study and piece of research has to be scrutinized, repeated and held accountable for findings. The problem is that there is a myth that we need more medications and I have read this numerous times. We don’t need more meds we need feedback from people who are on meds, we need very careful research and we need for insurance and private equity companies to fund respites in every area. Government won’t do this for us.

If reform means throwing away the good with the bad then it should never and will never come about. I hope you accomplish more than staying safe and healthy and fearing the worst. Hope you can be happy also.

As long as you continue to perceive and label me as an authority figure and making “authoritative statements and authoritative analysis” we are unable to meet as equals. There is a fear and a rage against those who are seen as authority figures and not as qualified professionals discussing the way forward in the mental health system.

Again, “delusions of grandeur” is a telling phrase to use. It appears that people who hold on to their anger, their feelings of being violated (or raped as one commenter described it) and to continue to re-open old wounds also tend to have behaviors that resemble the oppressive forces that they are so angry and afraid of. For example; there is a sense of entitlement here the power to label all who do not agree in terribly pejorative terms, there is a perception that anyone who does not agree is pathological (the word delusional is used by the medical community to describe irrational beliefs and perceptions) there is that black or white mode of categorizing that leaves no room for discussion or disagreement. The comments are punitive and demeaning and create no space for divergent thoughts. Does this not resemble the M.O. of oppressive forces?

I am not sure how to interpret the comments on your article. You are one of the few people who are able to view an issue without the rage and blame that is so daunting and that obscures any message being put forth except for those who are equally enraged. I truly think that constantly re-opening wounds and persistently arguing over words that describe these wounds is not helpful. The mind gets stuck in one track and peripheral blindness occurs. Here is a quote that best sums it up for me.

Seeing mental illness: Elyn Saks at TEDGlobal2012 http://blog.ted.com/seeing-mental-illness-elyn-saks-at-tedglobal2012/
She is, she said, “Very pro-psychiatry and very anti-force…. Force is a terrible thing to do to another person with a terrible illness.”
What schizophrenia is
Schizophrenia is a brain disease, and the defining feature is psychosis — or being out of touch with reality. Involving loose associations and hallucinations. For example, during her episodes she often has the feeling that she had killed hundreds of thousands of people with her thoughts, or that nuclear explosions are about to be set off in her brain. She reminds us that, “It is not the same as multiple personalities. It’s not split, but shattered.”
Eventually she realized she needed to take more medication. The wall between the sick woman and the professor was smashed.
She notes: “Everything about this illness says I shouldn’t be here. But I am.” There are reasons she’s here today, able to talk to us:
1. She has had excellent treatment, including psychiatry and psychopharmacology.
2. She has amazing friends and family. Relationships that “have given my life a meaning and a depth.”
3. The USC Law School is enormously supportive. It is also intellectually stimulating, and occupying her mind is one of the best defenses she has.
But she still didn’t make her condition public until recently, out of fear of the strong bias against those with mental illness. If we hear only one thing from the talk, what she would like us to hear is, “There are no ‘schizophrenics,’ only people with schizophrenia. We must stop criminalizing mental illness. It’s a national tragedy and scandal that the LA Country Jail is the biggest psychiatric hospital in the United States.”
She has tried to get off medications, as a way to prove she wasn’t ill. It didn’t work. She began seeing evil beings; at one point she ended up in the office of a consulting doctor who’d thought she had a mild case of schizophrenia. She showed up in his office, curled up in a ball and said, “Is it OK if I totally trash your office? I’m God, or I used to be Recently, a friend posed a question for her, “If there was one pill that would immediately cure you, would you take it?” Rainer Maria Rilke famously said he’d refuse psychotherapy — saying, “Don’t chase my devils away, because my angels may flee too.” Saks, on the other hand, would take that pill in a heartbeat. But she doesn’t wish to be seen regretting the life she could have had, nor does she want pity. What she wants is what everyone wants: “To work and to love.”

Again,, we don’t know what Mary was referring to; as I said she did not want to leave the ER that much I could infer by her behavior but the rest? Lets not assume we know what “that” is because we do not. If indeed she meant that she did not want to go to a hospital…I get that but again we are stepping into an area of meaning that is clear to her via her experiences and we have no idea what those were.

A question; We talk a great deal about “free will” about freedom of choice, about self determination and the gist is that no matter what age a person is, what condition they are in, what drugs or alcohol or toxic substances are in their systems that they must be allowed to do what they believe is best for them. At what age does free will begin? One of the people who commented on this article noted that her 2 year old said “no” a lot at that age. Most kids do, of course, to assert their independence. Again at what age does a person have free will, freedom of choice, etc.?

One problem here is that we can’t generalize and assume. Each person’s experience in a psych ward is different, people come in with varied and unique lives, expectations, fears etc. Each psych unit is as different as the staff and culture of that particular unit is. Before assuming and generalizing it is important to ask the questions about the environment and it’s culture. We can’t label people nor can we label mental health professionals or the places that they work in. I thought that this was one thing we agreed upon…not to generalize, label and assume?

I will reply briefly. I have worked in the same in-patient unit that Mary went to for over 17 years and the psychiatric ER in that same hospital where a team will read the 72 hour application for a hold and decide as a team if she is to be admitted or not. I know where I sent her with my recommendations that they pursue finding family etc. I have no need to defend my actions I believe what I did gave her time and people to talk to about what she needed to do to find her own way to where she would be most comfortable…and safe. Perhaps others could have left Mary under a bush and walk away confident that she was able to determine the way that she wanted to live her life. you did not talk to her, see her etc and therefore you have no idea what her history was, why she didn’t want to leave the ER and go to a hospital. She couldn’t tell me that so I dare not put words into her mouth or thoughts into her head and assume that she had been mistreated before. I have to refrain from guessing or assuming what her experiences were and go with the present situation. I am truly sorry that you were unable to make changes after your 2 year experience and that is not my experience. I do not bribe or hide what I do when I buck the system and that is just who I am. Also I am a bit curious why you vent such angry feelings and label my article a sob story and actually the food in the in-patient unit is the same food served in the cafeteria for the staff. I ate there each day and also ate with the patients during our group sessions.

Yes, a rude awakening but this is not unusual and parents/families struggle with guilt even thought it is often not their fault at all. But what would you be able to walk away from that bush and leave her there?

Thanks for the comment. I just wonder; if Mary were the daughter of any of the readers here and she refused to be helped by them and her only plan was to live under a bush and be an abused target for any predator, would any of the readers ask me to just let her make her own decisions and go back to the bush, to starvation, to abuse ? I have never had a family member ask me to step away and let a very confused, disorganized, abused and homeless person go back to a dangerous situation. Never happened. They ask me to keep the person safe any way that I can.

I believe that we are all focused upon and heading towards the same goals and views; people in states of emotional distress need intense support and time for them to begin the recovery process. Each person’s experiences are unique and medication does not promote the healing process. The healing or recovery process may incorporate the experiences that they are going through and medication only disrupts and distorts this unique process. Hospitalization is NOT part of the healing process it may be traumatizing and when meds are used it does not facilitate the integration and understanding of the person’s unique experiences.
The thing is that we are moving towards these goals in different ways. I am working inside the oppressive, often insane and resistant system itself. There are very few who are doing this (in the Emergency Rooms, Jails and in-patient units). I would indeed have an easier time if I took the advice of one of the commenters and went to work in a respite but that would not help achieve the goals. I need to be where I am to change minds.
I do have a question about self-determination, and safety issues. I have worked with very suicidal people in some cases where I actually had to ask the person to give me the weapon they were going to use. When they have time to reflect and someone to talk to many of them change their minds and then are very very relieved that they did not kill themselves. Time and talking are so important in these cases that I will do almost anything to buy time for them. In this regard, the systems I work in are completely against providing those 2 vital elements. It is a constant battle of wills but this is what goes on inside an autocratic, profit-oriented system.

Can you please clarify and expand this post? I would like to know of family members that have benefited from involuntary treatment. I have worked in-patient psychiatry and psych er for over 20 years and I do know of benefits although they may be short term. Please give a bit more descriptive examples.
Thanks

I hear your anger and I believe that it is about the system and not me personally. My choice for this poor woman was to keep her from being beaten up physically in the bushes outside of the hospital. I couldn’t have lived with myself if that had happened. Yes, sometimes there are bad choices and worse choices but I stay motivated to create a respite in my area which has absolutely nothing for people in crisis. If I took the anger that you expressed as a personal blow I would not have the self-confidence nor the strength to move forward for people like Mary.

Ted, we learned in the 1960’s that in order to achieve social control one must isolate individuals, reduce them to in-fighting and thus destroy solidarity. They do this in prison and jail with great success. The powerful forces in our society are well educated in this process and they are doing it with many reform movements, in fact they have insiders who are taught to do these kind of disruptive acts within the reform movements themselves. I keep seeing it happen and it is so very discouraging. Your idea is great however it kind of makes the movement exclusive and almost needing an evaluation before your are admitted to the group. What do you think?

Thank you for your comment. Of course, isolation is one of the most effective strategies for social and psychological control and then abusing the vulnerable individual further reduces the ability to trust, to reach out for support etc. Many injustices are hidden in this society; I am researching the current practice of coercing mentally ill women to be sterilized in order to get reduced sentences in jail and in prison. This began in 1909 and is still going on. There is a case in Tennessee right now and other cases in Georgia. Can you imagine the terror, the anger, the guilt of having to make such a decision when you are in emotional pain and incarcerated? I have a great deal of info on this and if you are interested I can send you the article link.
Again, thanks for your comment.

Dr Hoffman
Thank you for your eloquent comment; where may I find your writings? I read all of your posts and would like to have much more at hand and in mind. I use the word “digest” a great deal, I like “metabolize” as another gustatory and descriptive word.
I await your reply
Margaret

A general and wholehearted thank you all for your comments and encouragement. I have just joined an organization for social justice and have offered my voluntary services in their on-line Q and A site or in writing articles for them.
Onward we go

Getting people out of the correctional system is a process that involves their public defender, the judge and proof that they would do well in another setting. This is something I have done many times; judges differ in their understanding of emotional distress, abuse issues etc. and so do public defenders. Some of them are completely biased, others are more informed. I always refer them to MIA for information and hope that they look at the site and read the comments. I often find the comment are more informative than the articles themselves. Such as yours. Thank you

Right, one problem is that the wait time in the ER is hours long and police just don’t have time to await the ER triage procedure. Now, ER’s have cut staff in order to save money and the problem is worse. I found it profoundly sad to see police waiting their turn to get a person evaluated. If they book him or her into jail it is faster but then the individual will languish in jail due to the backload of court cases. It’s a no win situation due to economic forces and hospitals are streamlining to cut costs. Police should have priority in the ER but the ER is a medical domain and emotional issues are, believe me, not considered important.

Thank you for noting that “delusions” are subjective and that this word covers a multitude of experiences that occur with everyone. This is one of the terms that need to be eliminated from the vocabulary of anyone involved in the field of psychology or the social sciences.

Thank you! I am thinking of ways that people who have been harmed, betrayed and dehumanized by the system can influence others and, for now, since I have some ways to get the message out in the correctional system I would just appreciate your support and links ( if you have them) to any informative information about side-effects or withdrawal problems etc. I use the MIA information but could use other resources while I pursue the jail issue. So thanks for your encouragement….believe me I have a lot of powerful influences that are obstacles in my path so I can use all the support that you and others give me! Thanks again, Margie

What I am doing is following the Federal Investigation and gathering names and email locations for those who are involved. Also I have contact with jail clinicians and I am encouraging them to read the MIA articles on psychiatric drugs, withdrawal etc. In addition I am sending these works to Washington Post and other journals and as a writer on Psychcentral Pro I am working on articles for that site. I think that others might forward MIA articles on to these sites? The clinicians in the jail (I supervised masters level USC students) are completely uninformed about the harmful effects of psych drugs! I think this is a beginning but I am going ahead full steam at this point. Your encouragement is what I need now and so I thank you with all of my heart, Ted.

Yes research and the courage to move ahead and design a plan that works for you. That, along with journalists who do a great deal of the probing and investigating, is the way to begin to take some control over a dehumanizing and destructive medical process. You are so right!

Thank you for an honest disclosure. As a clinical social worker struggling now with writing about the issues that matter to us and that clearly disturb the establishment I can confirm all that you say about money not being a motive or incentive for doing any of our work. What we lose financially, we gain morally and emotionally.
We really don’t have to defend ourselves….do we?

You are so right, it is a message and I hope that others will look beyond the outer and sometimes unusual presentation of many people who are in emotional pain and see the small, abused human being who is hiding in his or her “closet” due to fear.

This is terribly disturbing and it probably is not the only case of it’s kind. Money cannot make up for the tragedy in the children’s and mother’s life. Yes, labels have to be thrown out with the garbage. We refuse to acknowledge them, we write about how damaging they are, we can use new language but many have suffered and are still being oppressed.
Thank you for the comment and the link

Thank you for your comment. Do you know that most of the people who were labeled “Schizophrenic” in the in patient units, the ER and the jails were some of the nicest, most frightened people that I have ever come into contact with. When I was out sick for a day, they were the ones who asked how I was feeling and said that they “missed” me.

Please let me thank all of the thoughtful and compassionate people who respond to my post. I have not, in the past shared my personal stories….but I feel safe here to share and to promote alternative ways of helping individuals through their terrible periods of distress. As a therapist and a survivor I did use non-medical and non traditional ways of helping people trapped in the locked wards and jails but here I have found new ways of thinking about what I was doing and how it helped. This forum is amazing and stimulates me to reach out with renewed energy and with your support.

Great!
Also, David Fox and I (he is an author on this site) are just completing a book that challenges all of the social/psychological assumptions regarding our mental health system. Your story (as a narrative) would be an inspiring addition. What do you think? Let me know. My email is[email protected]

Let me know when you are ready to fight for change…..I will join in. However, as you know, hospitals are now on the no-fund list so diverting money is not an option, States and the Fed have decided to put funds into the out-patient system since this is more economical than funding in-patient beds at 800 per day. The better option is to work on the medication issue; I know from experience that the drugs used as a first line treatment are only used once and then we wait and if I am on the case I try desperately to find family or friends. It’s a very tough situation with dozens of people coming in, less and less staff, no beds and people in terrible states, physically and emotionally. They are usually medically sick as you can imagine.

Hundreds of people who are brought into the psych emergency or medical emergency rooms have no families to be with them 24/7, . I worked with individuals who have been homeless for years and there is no one to care for them when they are in extreme states. The respite centers are few and far between, not anywhere near Los Angeles and beds are limited. Mostly families who can do a bit of research can access these preferred environments. I am referring here and talking about a population that has no one to turn to. That is why they wind up sitting in isolated jail cells, in great emotional pain for months and months, no family or friends to advocate for them. Again, this is a huge population that is invisible to most people unless you work with them

I am very grateful and relieved to see emotionally tempered responses now. I have worked in the emergency rooms, in jails, in county locked units and I have seen extreme states that needed medication as a first line strategy for avoiding self-injury. There is no warm and loving embrace for an individual who is so agitated, in such distress that they are willing and capable to harming others in order to be able to harm themselves. Again after this there should be a full evaluation and then reconsideration of what kind of intervention is needed. Unfortunately this does not happen in crowded, emergency departments or jail. So the failure is on the second step and that is only going to become worse since beds are being cut and resources allocated to the AOT and community mental health centers that don’t usually see individuals who are in emergency states of distress. There are several populations that we are dealing with here; the extreme, emergency states of emotional distress and then the serious, persistent states that can be and should be managed very differently. We need to be clear about differences in intensity of emotional pain as well as the context and situation that they are in. Treating everyone alike is not realistic or helpful.